In the evolving landscape of healthcare, particularly within post-acute care settings, the need for standardized assessment tools has become increasingly critical. One such pivotal tool is the Continuity Assessment Record and Evaluation (CARE) Item Set, designed as an Acute Care Acuity Tool to bridge information gaps and enhance patient care across different healthcare environments. This article delves into the CARE Item Set, its development, purpose, and significance in modern healthcare.
What is the CARE Item Set?
The CARE Item Set emerged as a direct response to the Medicare Post-Acute Care Payment Reform Demonstration (PAC-PRD). This demonstration, initiated by the Deficit Reduction Act of 2005, aimed to standardize patient information to better understand payment incentives across various healthcare settings, including acute care hospitals, long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs).
At its core, the CARE Item Set functions as an acute care acuity tool by providing a uniform method to evaluate a patient’s health and functional status. It is applied at the point of discharge from acute care hospitals and upon admission and discharge from post-acute care facilities. By collecting standardized data, the CARE Item Set enables healthcare providers and policymakers to gain insights into:
- The consistency of patient treatment across different care settings.
- Resource utilization and associated outcomes in each setting.
- The extent to which similar patients are treated in varying environments.
- Appropriate payment reform recommendations based on patient needs and care complexity.
Expanded under the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), the Medicare PRD and consequently the CARE Item Set, further allowed for the examination of acute hospital payments for medically complex populations, reinforcing its role as a vital acute care acuity tool.
Key Features of the CARE Item Set
The CARE Item Set is meticulously designed to standardize the assessment of patients across the continuum of care. Its key features emphasize its function as an effective acute care acuity tool:
- Standardized Assessment: It provides a consistent framework for evaluating patients’ medical, functional, cognitive, and social support status across acute and post-acute care settings. This standardization is crucial for accurate comparisons and informed decision-making.
- Minimal Administrative Burden: The tool was developed with the aim of integrating standardized items into existing assessment processes, thereby minimizing additional administrative work for healthcare providers.
- Comprehensive Measurement: The CARE Item Set targets a broad spectrum of measures that document variations in a patient’s level of care needs. This includes factors influencing treatment and staffing patterns, such as predictors of physician, nursing, and therapy intensity.
- Two-Tiered Item Structure: To ensure detailed and relevant data collection, the CARE Item Set incorporates two types of items:
- Core Items: These are fundamental questions asked for every patient within a setting, irrespective of their specific condition.
- Supplemental Items: These condition-specific questions are used to provide a more granular measurement of severity or need for patients with particular conditions. For instance, while the core item might identify the presence of a pressure ulcer, supplemental items would delve into the specifics, such as stage and number.
This two-tiered approach enhances the CARE Item Set’s precision as an acute care acuity tool, allowing for both broad applicability and detailed condition-specific assessments.
Development and Testing of the CARE Item Set
The development of the CARE Item Set was a rigorous 14-month process, grounded in scientific literature and practical experience with existing assessment tools like the IRF-PAI, MDS, and OASIS. The focus was on selecting items directly relevant to patient severity, payment considerations, and quality of care monitoring, solidifying its function as a reliable acute care acuity tool.
Key principles guiding its development included:
- Maximizing Reliability and Validity: Ensuring the items accurately and consistently measure what they are intended to measure.
- Breadth of Application: Minimizing floor and ceiling effects to effectively assess a wide range of patient acuities.
- Minimizing Unintended Incentives: Avoiding the creation of incentives that might encourage provider behaviors not aligned with best care practices.
The CARE Item Set represents a framework for a standardized set of items that can be accessed through an item bank. Items used solely for care planning in existing tools were intentionally excluded to maintain focus on acuity and payment-related factors.
B-CARE: A Streamlined Approach
Building on the foundation of the CARE Item Set, B-CARE emerged as a streamlined version tailored for use within the Bundled Payments for Care Improvement (BPCI) Initiative. B-CARE retains the essence of an acute care acuity tool but is optimized to provide consistent information across BPCI models and care settings.
The purpose of B-CARE is to:
- Monitor the impact of care redesign on patient health status and outcomes within bundled payment models.
- Understand how patient mix affects results across different BPCI models and settings.
By providing a consistent and efficient acute care acuity tool, B-CARE supports the goals of bundled payment initiatives to improve care quality and efficiency.
Conclusion
The Continuity Assessment Record and Evaluation (CARE) Item Set stands as a significant advancement in healthcare assessment, particularly as an acute care acuity tool within post-acute care. Its development and implementation reflect a commitment to standardized, data-driven approaches to patient care and payment reform. By providing a consistent and comprehensive method for evaluating patient acuity and needs, the CARE Item Set and its streamlined version, B-CARE, contribute to improved patient outcomes, enhanced care coordination, and more equitable payment models in the evolving healthcare landscape.
Useful Links
- Overview of the Medicare Post-Acute Care Payment Reform Initiative
- Section 5008. Post-Acute Care Payment Reform Demonstrations Program. Deficit Reduction Act of 2005
- Post-Acute Care Payment Reform Demonstration: Final Report
- Report to Congress: Post Acute Care Payment Reform Demonstration (PAC-PRD) (PDF)
- Post-Acute Care Payment Reform Demonstration Report to Congress Supplement-Interim Report (PDF)
- Post-Acute Care Payment Reform Demonstration: Final Report. (PDF) Volume 2 of 4 (PDF)
- Bundled Payment for Care Improvement (BPCI)
